Provider Demographics
NPI:1346448073
Name:AVVARU, ROHINI (SA-C)
Entity Type:Individual
Prefix:
First Name:ROHINI
Middle Name:
Last Name:AVVARU
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24513 BAY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-4013
Mailing Address - Country:US
Mailing Address - Phone:414-628-6901
Mailing Address - Fax:
Practice Address - Street 1:24513 BAY CREEK LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-4013
Practice Address - Country:US
Practice Address - Phone:414-628-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical